Provider Demographics
NPI:1952911752
Name:CHANG, JEFF WOOHYEOK (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:WOOHYEOK
Last Name:CHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 476 BOX 3109
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96322-0032
Mailing Address - Country:US
Mailing Address - Phone:315-252-2076
Mailing Address - Fax:
Practice Address - Street 1:PSC 476 BOX 25
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96322-0001
Practice Address - Country:US
Practice Address - Phone:315-252-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03005700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist